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Senior professionals in child health have said six out of 10 stroke cases in children in the country are linked to sickle cell anaemia, among other causes such as heart diseases and infections.
The experts added that infections, hypertension and kidney disease in pregnancy increased the risk of stroke in unborn babies, noting that prolonged labour also puts the baby at risk of stroke.
In separate interviews with PUNCH Healthwise, the paediatricians decried the labelling of children with symptoms of stroke as “possessed”, and urged parents to seek appropriate medical help when they observe unexplainable symptoms in their children.
They noted that stroke in children was preventable and treatable, adding that mild cases could have their effects reversed with appropriate physiotherapy.
According to Stroke.org, stroke is a disease that affects the arteries leading to and within the brain and is the fifth cause of death and the leading cause of disability.
Johns Hopkins Medicine notes that paediatric stroke is a rare condition that affects one in every 4,000 newborns and 2,000 older children every year.
The incidence of stroke in children in the United States of America was five per 100,000 children, while it was 2.1 per 100,000 in China.
Data from the Paediatric Association of Nigeria reveals that the incidence rate was about 1.8 to 13 per 100,000 children under the age of 18.
It added that in Nigeria, six to eight per 1,000 children who are admitted into tertiary hospitals have a stroke.
It also noted that the incidence of stroke was more prevalent in black African countries than in children among Caucasians due to the major role sickle cell disease plays in stroke in children.
Commenting on the issue, the President of the Paediatric Association of Nigeria, Prof Ekanem Ekure, stated that for children in Nigeria, the leading cause of stroke was sickle cell disease.
SCD is an inherited blood disorder in which the haemoglobin in the red blood cells is prevented from carrying oxygen to all parts of the body.
She noted that six out of 10 children diagnosed with stroke were due to sickle cell disease.
The don said, “In the older children, other important causes are infections of the brain like meningitis, diarrhoea, HIV, chicken pox and congenital heart disease, especially the cyanotic congenital heart disease where the oxygen level in the blood is low and makes the baby blue. The body tries to compensate by producing more blood cells resulting in very high levels of blood. A common one is called Tetralogy of Fallot where the children get tired easily and like to squat.
“Acquired heart conditions can also cause stroke in children. These include rheumatic heart disease, cardiomyopathies and infection of the heart (infective endocarditis). Some children with Down syndrome have a higher risk of stroke which could be from an associated heart disease or blood disease such as Moya Moya disease where some brain vessels tighten and ultimately get blocked. Cancers in children like leukaemia, lymphoma and brain tumours are recognised causes of stroke. Simple infections like tonsillitis (infection of the throat), otitis media (infection of the middle ear) may be complicated by meningitis which can then lead to stroke.”
Although stroke could occur at any age in childhood, Ekure noted that the risk of stroke in children was highest between the fifth month of pregnancy and the end of the first week of life.
“But for sickle cell disease which is the major cause of stroke in children in Nigeria and black children generally, the risk of stroke is highest between the ages of two and nine years,” the paediatrician added.
The don stated that increased enlightenment, better education, expertise and facilities had increased the rate of accurate diagnosis of strokes in children.
“Globally, stroke is estimated to be one of the top ten causes of death in children. In the past, strokes were frequently misdiagnosed or underdiagnosed, but we know that strokes in children are more common than is currently estimated,” she said.
Ekure further noted that infections in the mother, hypertension and kidney disease in pregnancy increased the risk of stroke in the unborn baby, noting that at the time of delivery, prolonged labour could cause a stroke.
The PAN president added that after birth, infections, dehydration from poor feeding, vomiting or diarrhoea could cause reduced blood flow to the brain and cause a stroke.
She asserted that stroke was treatable and due to brain plasticity, children had a higher chance of making total recovery.
The paediatrician advocated proper management of pregnancy and deliveries, vaccinations to prevent infection, good hygienic practices, and yearly transcranial Doppler screening from age two to 16 years for sickle cell disease patients.
The PAN president called for public enlightenment, adding, “The Paediatric Association of Nigeria advocates that Comprehensive cardiac care for children should be included in the National Health Insurance Act. This will enable children like this to have cardiac surgery early and avoid life-debilitating complications such as stroke.”
Also, a Paediatric Neurologist at Aminu Kano Teaching Hospital, Kano State, Dr Umar Sabo, stated that sickle cell was the common cause of stroke in children, among other causes.
He added that obese children were at an increased risk of stroke and blocked arteries.
The paediatric neurologist noted that although there was no nationwide data to show the stroke incidence in children, increased awareness, improved health-seeking behaviour, improvement and ease in diagnosis could account for the seeming rise in cases.
Sabo further noted that aside from genetic and dietary predisposition, children are at increased risk of stroke before and during the first month of life.
“The greatest risk for stroke is in utero before the baby is born, and the first month of life. So, in children, the period of great risk of having a stroke is before the child is born, and then especially the first month of life,” the consultant paediatrician said.
Sabo further explained that severe infections, trauma and clotting abnormalities were some of the major causes of stroke in the newborn.
He added that smoking and substance use, especially cocaine and other hard drugs, increased the risk of vascular accidents, leading to stroke in neonates or the foetus.
The child expert also noted that premature delivery and difficult delivery could cause bleeding into the brain of a neonate, especially in preterm babies.
He further noted that because children’s brains had a greater tendency of plasticity, which is the ability to regenerate, children with stroke who had appropriate supportive measures could regain their function, compared to adults.
The child neurologist, however, noted that strokes still left permanent damage in children who had them.
“Even those that have a stroke in utero, before they were born, there are some that will end up having physical deformity, intellectual deformity, because of the stroke they have in utero. So, yes, there is a chance, if you do everything measured equally, the child may have a better outcome than an adult. But still, there are a lot of people that end up with permanent neurologic deficits after stroke,” he said.
Sabo emphasised that preventing the occurrence of stroke was important, noting that the treatment of stroke in sickle cell patients was completely different from a conventional stroke caused by other diseases.
He added that the treatment of stroke in sickle cell patients involved blood transfusion, stating that the daily use of hydroxyurea drug could reduce the risk of stroke by up to 70 per cent.
The paediatric neurologist further debunked the myth that babies with stroke were witches and called for more awareness of stroke incidences in children.
Another consultant paediatrician, Dr Ayodele Renner, confirmed the global rise in stroke incidence in children.
He noted, however, that stroke cases in Nigerian children mostly occurred among those with sickle cell anaemia,
“They say that up to 11 per cent of children that have sickle cell anaemia will have a stroke before their 20th birthday. Usually, it (stroke) occurs between the ages of two and five in such children. But for children without sickle cell anaemia, it’s very difficult to pinpoint the incidence of stroke. That’s because stroke is not as common in that group of children as in children that have sickle cell anaemia.
“However, newborn babies can have certain types of strokes and stroke-like syndromes such as birth asphyxia and things like meningitis,” Renner said.
He further clarified that the risk factors of stroke in adults differed from children, noting that although more children were coming down with obesity and hypertension, there was no record of its link to stroke.
Renner asserted that stroke in children was treatable, adding that children who had a mild stroke could recover full function of the affected body parts with intensive treatment and physiotherapy.
Since children with sickle cell anaemia were those at risk of stroke the consultant paediatrician advocated genotype testing for intending couples to help them make informed decisions.
He noted that to prevent stroke in children with sickle cell anaemia, measures such as screening, chronic blood transfusion therapy, and hydroxyurea were effective methods.
Renner advocated exercise, adequate sleep, a healthy diet of fruits and vegetables and avoidance of refined foods to prevent non-communicable diseases like hypertension and obesity in children.
